Missouri

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Glossary of Terms

OVERVIEW:  Missouri has no free care law.  The definitions that exist for bad debt and charity care pertain only to a) hospital reporting and b) reimbursements for hospitals that provide a disproportionate share of safety net services and care to the uninsured. 

CITATION:
Health Care Providers, Data Requirements
Missouri Revised Statutes §§ 192.665 to 192.667

Missouri Healthnet Division: Hospital Program
13 Missouri Code of State Regulations 70-15.010

Hospital and Ambulatory Surgical Center Disclosure
19 Missouri Code of State Regulations 10-33.030

TERMINOLOGY:
Charity care

REGULATORY OVERSIGHT:  The Department of Health has oversight authority for hospital reporting of financial data, which includes bad debt and charity care expenses.  Mo. Code Regs. tit. 10, § 33.030. 

DEFINITIONS AND DISTINCTIONS:
For purposes of determining a hospital’s reimbursement through Medicaid Disproportionate Share funds, the following terms apply:

“Bad debt” includes “the costs of caring for patients who have insurance but are not covered for the particular services, procedures or treatment rendered. Bad debts should not include the cost of caring for patients whose insurance covers the given procedures but limits coverage. In addition, bad debts should not include the cost of caring for patients whose insurance covers the procedure although the total payments to the hospital are less than the actual cost of providing care.” Mo. Code Regs. tit. 13, § 70-15.010(2)(B).  

“Charity care” is defined as “result[ing] from a provider’s policy to provide health care services free of charge or a reduction in charges because of the indigence or medical indigence of the patient.”  Mo. Code Regs. tit. 13, § 70-15.010(2)(E).  Charity care must be included and is distinguished from bad debt in the annual financial report hospitals submit to the Department of Health (see Reporting Requirements below).  Mo. Code Regs. tit.19, § 10-33.030, Exhibit D.

FREE CARE AS A COMMUNITY BENEFIT: N/A

ELIGIBILITY REQUIREMENTS: N/A

FINANCING SOURCE:
As part of the regulations governing Missouri’s Medicaid program, there is a provision allowing for hospital reimbursement for the cost of care rendered to uninsured patients, as defined in regulation.  Mo. Code Regs. tit. 13, § 70-15.010(18)(B).  Generally, hospitals are reimbursed 89 percent of the cost of care provided to uninsured patients.  Id.   The cost of the uninsured is determined by multiplying the charges for charity care and allowable bad debts by the hospital's total cost-to-charge ratio for allowable hospital services from the base year cost report's desk review.  Id.  

SERVICES COVERED: N/A

NOTIFICATION REQUIREMENTS: N/A

APPLICATION PROCESS: N/A

GRIEVANCE/APPEAL PROCESS: N/A

REPORTING REQUIREMENTS:
All health care providers shall, at least annually, report financial data to the Department of Health.  Mo. Rev. Stat. § 192.667(1); Mo. Code Regs. tit. 10, § 33.030; see also Mo. Rev. Stat. § 192.665(4) (defining “financial data”).  Charity care is one of the elements that must be included in the financial report and is distinguished from bad debt.  Mo. Code Regs. tit. 10, § 33.030, Exhibit D.  It is not deducted when determining total gross patient revenue.  Id.  The Department of Health shall develop and publish reports pertaining to individual hospitals, which shall be public record.  Mo. Code Regs. tit. 10, § 33.030(2)-(3). 

PENALTIES FOR NONCOMPLIANCE: N/A

OTHER: N/A